Robotic prostatectomy, measured by the men who had it

Design

National registry cohort with multivariate adjustment, patient-reported outcomes (EPIC-26)

Population

4889 men having open (2844) or robotic (2045) radical prostatectomy in New Zealand, 2016 to 2024

Primary outcome

EPIC-26 domain scores at 12 months

Effect

Urinary incontinence +6.9 points (95% CI 4.6 to 9.2), sexual +11.4 (9.1 to 13.7) favouring robotic; zero pads 65.1% vs 54.4%

Four thousand eight hundred and eighty-nine men in the New Zealand prostate cancer registry completed EPIC-26 questionnaires around radical prostatectomy between 2016 and 2024 — 2844 open, 2045 robotic. Adjusted for age, PSA and ISUP grade, robotic surgery scored higher in every domain at 12 months.

Two differences cleared the minimal clinically important threshold: urinary incontinence by 6.9 points and sexual function by 11.4. Urinary obstruction, bowel and hormonal domains did not. The pad data make the incontinence figure concrete — 65.1 per cent using no pads at 12 months against 54.4, and 3.9 per cent using two or more against 10.0.

This is registry data, not a trial, and the men were not randomised. Surgeon volume, case selection and era all differ between the groups — robotic programmes concentrate in larger centres with higher-volume surgeons, which is itself associated with better continence. The comparison that matters to a patient is nonetheless this one: what happens to men in an actual health system, reported by them.

• Quote pad use rather than a score when consenting; 'about two in three men use no pads at a year' is what patients understand.
• Report sexual function honestly — only 13.7 per cent of the robotic group described it as good or very good at 12 months.
• Name surgeon and centre volume as part of the conversation, not just the platform.
• Baseline PROM completion was 52.3 per cent, so the responding population is self-selected.
• Where robotic access is limited, as in much of India, volume and technique remain the modifiable factors.

Why it matters

It answers the platform question with the outcomes men actually ask about, rather than with margin status.

Don't overread it

A non-randomised registry comparison; the robotic advantage may partly reflect where and by whom robotic surgery is done.

The statistics, in plain English

Minimal clinically important difference thresholds are what turn an EPIC-26 point difference into something a man would notice: 6 to 9 points for incontinence, 10 to 12 for sexual function. The adjusted differences here (6.9 and 11.4) sit just above their thresholds, which means statistically solid and clinically modest. Adjustment covered age, PSA and grade only — not surgeon volume, nerve-sparing intent or year of surgery, each of which plausibly favours the robotic group.

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